1
Data Analytics as a
Population Health Compass
Session: # 244, Date of Session: February 14, 2019
Tim Putnam, President/CEO, Margaret Mary Health
Anna Loengard MD, CMO, Caravan Health
2
Tim Putnam, President/CEO of Margaret Mary Health,
DHA,MBA, FACHE
Salary: Margaret Mary Health
Consulting Fees (e.g., advisory boards): National Rural
Accountable Care Consortium, Caravan Health
Anna Loengard, M.D., CMO of Caravan Health
Salary: Caravan Health
Consulting Fees (e.g., advisory boards): National Rural
Accountable Care Consortium, Caravan Health
Ownership Interest (stocks, stock options or other ownership
interest excluding diversified mutual funds): Caravan Health
Conflict of Interest
3
• Introduction
• Future of the Medicare Shared Savings Program
• Mining Data for Success in Risk-based Models
• Charting Your Course: View from the CEO’s Office
• Steps to Take Now
Agenda
4
• Analyze finance and quality outcome data reporting requirements
for the Medicare Shared Savings Program.
• Summarize Medicare claims data available to Medicare Shared
Savings Program ACO participants.
• Recognize the power of claims data leveraged through population
health software through visualizations of financial performance
metrics, quality indicators and network utilization projections.
• Analyze examples of data analytics, analysis, and projections
ACO participants are using to chart their course to better patient
care and sound finances.
• Summarize steps to take now to chart the course for ACO
participation to gaining access to Medicare claims data.
Learning Objectives
5
Introduction
6
Helping Providers Navigate the Challenges of Value-Based Payments
170 employees
17 Accountable Care
Organizations ranging from
5,000 to 230,000 attributed lives
CMS Practice Transformation
Network
>350 health systems
>14,000 clinicians
>500,000 attributed Medicare
lives
About Caravan Health
Network
Development
Data and Analytics
Practice
Transformation
Accountability and
Performance
Improvement
7
• Batesville, Indiana
• 2014 NRACO Founding Member
• ~$100 Million Net CAH
• SHO2 ACO- AIM Funded
– Margaret Mary Community Hospital
– Henry County Memorial Hospital
– 2 local independent physicians
• 2019 moving into a consolidated
ACO of SHO 1 and SHO 2
– To scale up to approximately
20,000 lives.
Margaret Mary Health
8
Suburban Health ACO 2 Results
Final MIPS Score
93.64
CMS 2017 Results Released 8/2018
Actual Savings &
Losses
Earned
Performance
Payment
PY Net Earned
Performance
Payment After AIM
Quality Score
$3,627,190 $1,675,430 $1,401,790 94.27
9
Quality Measures Year to Year
Margaret Mary Health
Benchmarks Measure Rates
2015 2016 2017
2017 Caravan
Health ACOs
2015
2016 2017
2016 to 2017 %
Change
Clinical Depression
Screening/ Follow
-
Up
Plan
60th <30th 40th 50th 24 25.16 46.04 83.00%
Screening for Future
Fall Risk
60th 50th 80th 80th
37.25
42.28 70.47 66.67%
Influenza
Immunization
50th 70th 80th 70th
56.86
76.56 86.07 12.42%
High Blood Pressure
Control
60th 50th 60th 70th 62.3 57.4 63.7 10.98%
HbA1c Control
* * * *
18.18
21.94 13.27 29.94 %
Statin Therapy
* * * * * 75.37 81.25 7.80%
10
The Future of the MSSP:
Heading to Risk
11
Uncertainty finally lifted for Medicare Shared Savings Program
Agreement period extended from three to five years and shared savings rate increased
significantly to 40% for BASIC levels A - B
CMS follows through on commitment to push risk
Elimination of Tracks 1, 1+, 2, and 3 and replaced with BASIC and ENHANCED options
BASIC option begins with one-sided risk but requires participants to take on increasing
levels of risk over the agreement period
Lower revenue (physician, rural, and smaller hospital-affiliated) given extra time in non risk
Continued expansion of non-financial benefits of risk participation
Several significant but small changes to benchmark calculations finalized
Risk score growth up to 3% over the agreement period will be recognized in updated
benchmarks
Bottom Line on Final Rule
11
12
Key Changes from the Proposed Rule
12
Improved opportunity to share in savings for
BASIC option ACOs
Improved opportunity to
share in savings for
BASIC option ACOs
Threshold for “low
revenue” increased to
ACOs with 35% or less
of their attributed
beneficiaries’ fee-for-
service expenditures
New “low revenue”
(physician-led) ACOs
may defer risk for one
additional year
New beneficiary
notifications may be
provided via email or
online patient portal
13
BASIC & ENHANCED ACO Options
13
BASIC
ENHANCED
Level A
Level
B
Level C Level D Level E
Risk Upside only Two-sided Two-sided Two-sided Two-sided
Shared
Savings
1st dollar savings,
rate of 40%
1st dollar
savings, rate
of 50%
1st dollar
savings, rate
of 50%
1st dollar
savings, rate
of 50%
1st dollar
savings, rate of
75%
Shared
Losses
NA
1st dollar
losses, rate
of 30%, not
to exceed
2% of
revenue or
1%
benchmark
1st dollar
losses, rate
of 30%, not
to exceed
4% of
revenue or
2%
benchmark
1st dollar
losses, rate of
30%, not to
exceed
nominal risk
standard
(currently 8%
of revenue or
4% of
benchmark)
1st dollar
losses, rate of 1
minus sharing
rate (40-
75%),
not to exceed
15% of
benchmark
QPP Status
MIPS APM
Advanced
APM
Advanced APM
14
How Do You Win in the MSSP?
Managing your patients better
than fee-for-service
Wellness
Prevention
Chronic Care Management
Behavioral/Mental Health Support
Post-Acute Care
Accurately coding chronic
conditions every year
Have actionable data to drive
strategy
Your path to... … Shared Savings
1
2
3
15
Mining Data for Success in
Risk-based Models
16
Use Data as a Compass
patient care, clinician satisfaction and financial performance.
Tracking Key Analytics
81% ↑
21% ↓
17%
13%
65% ↑
57% ↓
42% ↓
40%
37%
50% ↑
32%
29%
28%
10%
12%
8%
Reduce avoidable
emergencydepartment
visits and avoidable
inpatientadmissions
Preventreadmissions
through better care
transitions
Active managementof
high-need high-cost
patients
Manage/reduce post-
acute-care spendingand
quality
Reduce
avoidable/unnecessary
care
Increase referrals toACO-
based providers/reduce
networkleakage
Integratebehavioral Palliative care/hospice
health care intoprimary
caresettings
Top Priorities for Improving
Efficiency, Reducing Cost
A physician group
n =77
Both (hospital and physician group equally) + Ahospital
n =86
Source: Accountable Care Learning
Collaborative, Western Governors University
Where Do ACOs Focus For Success?
18
1. Key Performance Indicators
2. Quickly highlightscommon
demographics,cost, and
utilization metrics at thelevel of
practices and communities
3. Network Utilization
4. Identifies where assignable
populationreceives their health
care, to identify network leakage
and help develop a growth
strategy
5. Additional content and topics to
be included in quarterly releases
Key Performance
Indicators
Network
Utilization
End-of-Life
Post-Acute Care
Facility Performance
Bundled
Payments
Modules
19
Variation in Post-Acute-Care Costs
Mean (SD) for Home Health
PPPY is
$449 ($367)
Mean (SD) for Non-Swing
PPPY is
$647 ($421)
20
$10,682.0
$10,385.4
(2.8%)
$10,100
$10,200
$10,300
$10,400
$10,500
$10,600
$10,700
$10,800
Average Truncated PPPY Average PPPY after Saving in
SNF+HH
Saving Opportunity in Post Acute Care
If Communities reduced SNF+HH
PPPY to meet Caravan Health
Median (among similar size
communities) , the potential saving
opportunity is…
$115 M
The average potential
reduction in total PPPY is…
2.8%
Savings Opportunity in
Post-acute Care
21
Optimize SNF Partnerships
Population Financial Details
Cohort Period Total PPPY IP PPPY
SNF Swing
PPPY
SNF Non-
Swing PPPY
Home Health
PPPY
Hospice
PPPY
Community 2018 Q1 $12,014 $4,359 $6 $1,264 $586 $481
Community 2018 Q2 $12,572 $4,684 $9 $1,418 $589 $463
ACO 2018 Q1 $13,001 $4,559 $248 $1,205 $542 $568
ACO 2018 Q2 $12,896 $4,488 $196 $1,271 $512 $531
Caravan Health 2018 Q1 $10,890 $3,713 $254 $691 $498 $246
Caravan Health 2018 Q2 $10,682 $3,640 $250 $669 $459 $235
SNF Non-Swing PPPY
Hospital Happy: $1418
Caravan Health: $669
All Sample reports are from Compass Modules 2018Q2
Module 1 – Key Performance
Indicators
Hospital Happy
ACO Happy
Module 4: Post-Acute Care Analysis
Skilled Nursing Details
Skilled Nursing Summary Table
Facility Name SNF Type
Facility SNF
Episodes
Total Paid
Amount
Average SNF
Paid per
Episode
IP Readmission
Rate
IP Transfer
Rate
ED Visits per
100 SNF Days
Average Paid
SNF per Day
Average
SNF LOS
Ultra High RUG
Episodes Rate
Community Average
Non-Swing 417 $4,717,561 $11,313 10.8% 18.2% 0.4 $392 28.9 48.5%
Community Average
Swing 5 $55,835 $11,167 0.0% 0.0% 0.0 $1,396 8.0 N/A
ACO Average
Non-Swing 929 $10,465,280 $11,265 10.7% 25.6% 0.5 $347 32.5 38.6%
ACO Average
Swing 118 $1,856,530 $15,733 10.2% 11.0% 0.2 $1,533 10.3 N/A
Caravan Health Average
Non-Swing 34,540 $378,788,319 $10,967 11.2% 20.1% 0.4 $379 28.9 46.5%
Caravan Health Average
Swing 7,438 $128,056,868 $17,217 12.8% 7.9% 0.1 $1,565 11.0 N/A
Community Data
NPI Facility Name SNF Type
Community
SNF Episodes
Total Paid
Amount
Average SNF
Paid per
Episode
IP Readmission
Rate
IP Transfer
Rate
ED Visits per
100 SNF Days
Average Paid
SNF per Day
Average
SNF LOS
Ultra High RUG
Episodes Rate
#######
Care Village A
Non-Swing 144 $1,778,789 $12,353 11.1% 20.1% 0.4 $397 31.1 73.1%
#######
Care Village B
Non-Swing 75 $624,963 $8,333 10.7% 9.3% 0.3 $387 21.5 32.0%
#######
Care Village C
Non-Swing 71 $914,322 $12,878 5.6% 9.9% 0.2 $411 31.3 46.6%
#######
Care Village D
Non-Swing 40 $294,251 $7,356 17.5% 42.5% 1.3 $276 26.6 0.0%
#######
Care Village E
Non-Swing 16 $179,655 $11,228 12.5% 12.5% 0.0 $385 29.2 50.0%
#######
Care Village F
Non-Swing 7 $95,803 $13,686 14.3% 14.3% 0.0 $430 31.9 42.9%
#######
Care Village G
Non-Swing 6 $91,148 $15,191 0.0% 83.3% 1.7 $396 38.3 65.2%
Community Data
NPI Facility Name SNF Type
Community SNF
Episodes
T
o
t
ED Visits per
100 SNF Days
Average
SNF LOS
Ultra High RUG
Episodes Rate
Very High RUG
Episodes Rate
High RUG
Episodes Rate
Medium RUG
Episodes Rate
Low RUG
Episodes Rate
Rate of Episodes
with Rehab RUG
#######
Care Village A
Non-Swing 144 0.4 31.1 73.1% 15.2% 5.5% 2.8% 1.4% 97.9%
#######
Care Village B
Non-Swing 75 0.3 21.5 32.0% 54.7% 2.7% 1.3% 0.0% 90.7%
#######
Care Village C
Non-Swing 71 0.2 31.3 46.6% 38.4% 1.4% 5.5% 0.0% 91.8%
#######
Care Village D
Non-Swing 40 1.3 26.6 0.0% 25.0% 50.0% 12.5% 0.0% 87.5%
#######
Care Village E
Non-Swing 16 0.0 29.2 50.0% 37.5% 6.3% 0.0% 0.0% 93.8%
#######
Care Village F
Non-Swing 7 0.0 31.9 42.9% 42.9% 0.0% 0.0% 0.0% 85.7%
#######
Care Village G
Non-Swing 6 1.7 38.3 65.2% 22.5% 1.1% 5.6% 1.1% 95.5%
23
Optimize Home Health Partners
All Sample reports are from Compass Modules 2018Q2
Home Health PPPY
Hospital Excel : $831
Caravan Health: $459
Population Financial Details
Cohort Period Total PPPY IP PPPY
SNF Swing
PPPY
SNF Non-
Swing PPPY
Home Health
PPPY
Hospice
PPPY
Community 2017 Q4 $9,517 $3,457 $127 $507 $909 $197
Community 2018 Q1 $9,783 $3,451 $121 $506 $847 $217
Community 2018 Q2 $10,064 $3,565 $99 $564 $831 $210
ACO 2017 Q4 $10,013 $3,681 $120 $539 $1,016 $212
ACO 2018 Q1 $10,334 $3,680 $114 $552 $959 $237
ACO 2018 Q2 $10,637 $3,767 $117 $617 $963 $225
Caravan Health 2017 Q4 $10,331 $3,568 $232 $696 $451 $225
Caravan Health 2018 Q1 $10,890 $3,713 $254 $691 $498 $246
Caravan Health 2018 Q2 $10,682 $3,640 $250 $669 $459 $235
Module 1 – Key
Performance Indicators
Hospital Excel
ACO Excel
24
Module 4: Post-Acute Care Analysis
Home Health Details
Home Health Summary Table
Agency
Facility
Episode Count
Total HH Paid
Paid HH per
Episode
HH Episodes
w/ IP Rate
HH Episodes
w/ ED Rate
Average HH
LOS
Community 1,237 $5,562,110 $4,496 13.4% 18.9% 96.0
ACO 1,522 $6,886,656 $4,525 13.8% 19.4% 99.0
Caravan Health 55,258 $231,290,268 $4,186 14.2% 19.1% 68.0
Community Data
Agency NPI Agency
Community
Episode Count
Total HH Paid
Paid HH per
Episode
HH Episodes
w/ IP Rate
HH Episodes
w/ ED Rate
Average HH
LOS
####### HOME CARE A
333 $1,871,822 $5,621 14.4% 18.3% 115.0
#######
HOME CARE B 281 $802,316 $2,855 12.8% 17.4% 57.0
#######
HOME CARE C 139 $544,165 $3,915 10.8% 21.6% 81.0
####### HOME CARE D
74 $358,424 $4,844 16.2% 21.6% 96.0
####### HOME CARE E
65 $322,473 $4,961 6.2% 18.5% 120.0
#######
HOME CARE F 55 $289,880 $5,271 9.1% 20.0% 113.0
####### HOME CARE G
55 $264,510 $4,809 12.7% 29.1% 99.0
####### HOME CARE H
39 $165,927 $4,255 12.8% 20.5% 115.0
Caravan Health Data
Agency NPI Agency
Facility
Episode Count
Total HH Paid
Paid HH per
Episode
HH Episodes
w/ IP Rate
HH Episodes
w/ ED Rate
Average HH
LOS
####### HOME CARE A
672 $3,834,748 $5,706 15.3% 18.6% 106.0
#######
HOME CARE B 302 $857,096 $2,838 13.2% 17.5% 57.0
#######
HOME CARE C 163 $635,001 $3,896 11.7% 20.9% 79.0
####### HOME CARE D
77 $367,206 $4,769 15.6% 22.1% 94.0
####### HOME CARE E
159 $835,845 $5,257 13.2% 22.0% 116.0
#######
HOME CARE F 223 $1,332,711 $5,976 13.5% 25.6% 125.0
####### HOME CARE G
62 $303,378 $4,893 12.9% 27.4% 99.0
####### HOME CARE H
64 $267,866 $4,185 12.5% 14.1% 106.0
25
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2
5
End of Life Opportunity
1. End of Life (EOL)
Literature and our data both suggest that
there’s potential opportunity if patients
start hospice sooner.
If 100% Hospice patients start
hospice sooner and stay over 30
days, the total saving opportunity
is…
$47.8 M
(1.2% PPPY)
$83
$41
$21
$0
$20
$40
$60
$80
$100
100% 50% 25%
Potential Saving Per Person
by % of Hospice Patients
Hospice Stay >30 Days
100% 50% 25%
26
www.CaravanHealth.com | Proprietary & Confidential, Not for Distribution
26
End of Life Opportunity
All Sample reports are
from Compass
Modules 2018Q2
End of Life Experience: Last 6 Months of Life
Community Data by Length of Stay
Hospice LOS No Hospice 1-7 days 8-30 days Over 30 days Total
Patient Count 22 11 8 3 44
Percent of Total 50.0% 25.0% 18.2% 6.8% 100.0%
Total Cost at EOL $457,133 $342,210 $205,197 $54,355 $1,058,896
Average Cost at EOL $20,779 $31,110 $25,650 $18,118 $24,066
End of Life Key Statistics
Cohort Hospice Rate
Average Total
Cost
Community 40.0% $24,066
ACO 43.0% $30,052
Caravan Health 46.7% $34,361
27
Using Data to Drive Strategy
$28,584
$26,708
$25,791
$25,690
$24,500
$23,633
$23,250
$22,987
$22,313
$22,252
$21,955
$21,923
$21,879
$21,746
$21,580
$21,372
$20,692
$20,572
$20,455
$20,452
$20,417
$20,010
$19,956
$19,923
$19,849
$19,844
$19,765
$19,653
$19,407
$19,365
$19,097
$19,023
$18,942
$18,940
$18,868
$18,332
$18,155
$20,761
A3576
A2871
A2890
A2895
A3577
A2622
A2680
A2864
A3571
A2869
A2892
A2872
A2861
A3570
A2662
A2867
A2866
A3574
A3647
A2862
A2860
A3578
A2893
A3644
A2882
A2852
A2876
A2856
A3566
A2879
A2858
A3575
A3649
A3580
A3565
A3579
A3648
CH00
AVERAGE TOTAL COST OF MAJOR JOINT
REPLACEMENT OF THE LOWER EXTREMITY
BUNDLE
27
28
ACO ID
Clinical
Episode Count
Episodes per
1000
Patients
RAF
Median Total
Cost
Cost %
Difference
vs Caravan
75th
Average
SNF Cost
Average
Home
Health
Cost
Average
Part A
Office
Visit Cost
Average Part
B Office Visit
Cost
CH00
5860 9.20
0.785
$17,016
0%
$1,816
$1,575
$155
$129
ACO 1
360 13.03
0.758
$16,132
-
9%
$1,495
$572
$506
$102
ACO 2
339 9.40
0.850
$16,240
-
14%
$1,007
$1,912
$80
$170
ACO 3
302 7.81
0.824
$15,701
-
17%
$1,197
$1,543
$18
$207
ACO 4
269 8.24
0.680
$15,575
-
12%
$1,973
$1,799
$38
$152
ACO 5
217 7.71
0.847
$17,674
-
6%
$1,537
$2,022
$44
$152
ACO 6
142 8.02
0.800
$17,535
-
12%
$1,493
$1,755
$73
$205
ACO 7
95 5.27
0.874
$22,515
30%
$4,191
$2,645
$112
$167
ACO 8
93 11.20
0.771
$14,874
-
17%
$429
$1,238
$98
$152
ACO 9
90 7.11
0.676
$21,532
17%
$2,264
$1,990
$219
$112
ACO 10
74 5.26
0.873
$16,810
-
9%
$1,899
$1,055
$129
$99
ACO 11
50 4.78
0.842
$18,465
-
2%
$1,521
$1,911
$105
$134
ACO 12
46 6.26
0.769
$16,796
-
1%
$3,009
$1,275
$182
$94
Bundled Payment Episodes
28
29
Facility Level Examples-
Using Data to
Chart the Course
30
Benefits of Access to Medicare
Claims Data
Facility Network Utilization Analysis
Setting Total Inpatient Outpatient
Post-Acute
Care
In-Network $10,834,803 $3,617,804 $5,703,143 $1,513,856
Out-of-Network $20,675,359 $11,665,933 $4,428,330 $4,581,096
Facility Network Utilization
Analysis-2017
Top 10 Facilities by Total Payments
Name
Setting
Patient
Count
Total Inpatient Outpatient
Hospice
Swing
Bed SNF
Non
-
Swing
Bed SNF
Home
Health
MARGARET MARY COMMUNITY HOSPITAL
INC
IN
3,432 $9,178,292
$3,617,804
$5,560,488 $0 $0 $0 $0
THE CHRIST HOSPITAL
ON
346 $3,957,047
$3,340,774
$616,272 $0 $0 $0 $0
UNIVERSITY OF CINCINNATI MEDICAL
CENTER, LLC
ON
161 $1,731,167
$1,600,358
$130,809 $0 $0 $0 $0
ST. ANDREWS HEALTH CAMPUS
ON
133 $1,483,337 $0 $118,086 $0 $0
$1,365,252
$0
THE WATERS OF BATESVILLE
ON
93 $1,216,026 $0 $187,032 $0 $0
$1,028,993
$0
INDIANA UNIVERSITY HEALTH
ON
138 $1,072,981 $894,717 $178,264 $0 $0 $0 $0
THE GOOD SAMARITAN HOSPITAL OF
CINCINNATI, OHIO
ON
88 $811,033 $691,234 $119,799 $0 $0 $0 $0
DECATUR COUNTY MEMORIAL HOSPITAL
ON
408 $808,216 $313,981 $494,235 $0 $0 $0 $0
MARGARET MARY HEALTH HOSPICE
IIN
71 $778,608 $0 $0
$778,608
$0 $0 $0
MARGARET MARY COMMUNITY HOSPITAL
INC
IN
207 $735,248 $0 $0 $0 $0 $0
$735,248
32
Network Utilization Part A
DRG Severity-2017
Setting
Low Weight
DRG Total
Paid
Low Weight
DRG
Percent of
Setting
Medium
Weight DRG
Total Paid
Medium
Weight DRG
Percent of
Setting
High Weight
DRG Total
Paid
High Weight
DRG
Percent of
Setting
In
-Network
$1,194,980
36.7%
$1,801,555
44.9% $566,101 7.9%
Out
-of-
Network
$2,063,523
63.3%
$2,214,347
55.1%
$6,625,614
92.1%
Network Utilization Part A- Top 5 DRGs
by Admission Count- Per Setting-2017
Setting DRG Name
DRG
Code
DRG
Average
Facility
LOS
DRG
National
Average
LOS
DRG
Patients
Served
DRG
Weight
Admission
Count
Paid
Amount
DRG
Rank
by
Admission
Count
In
-
Network
SEPTICEMIA OR SEVERE SEPSIS W/O MV
>96 HOURS W MCC
871 3.9 6.4 42
Medium
42 $458,742 1
In
-
Network
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE W MCC
190 3.0 4.8 27 Low 37 $296,939 2
In
-
Network
HEART FAILURE & SHOCK W MCC
291 2.9 5.8 26
Medium
27 $216,674 3
In
-
Network
RESPIRATORY INFECTIONS &
INFLAMMATIONS W MCC
177 3.8 7.4 22
Medium
23 $252,147 4
In
-
Network
MAJOR JOINT REPLACEMENT OR
REATTACHMENT OF LOWER EXTREMITY
W/O MCC
470 2.8 2.9 21 High 21 $154,142 5
Out-of-
Network
MAJOR JOINT REPLACEMENT OR
REATTACHMENT OF LOWER EXTREMITY
W/O MCC
470 2.6 2.9 45 High 47 $532,953 1
Out-of-
Network
SEPTICEMIA OR SEVERE SEPSIS W/O MV
>96 HOURS W MCC
871 8.1 6.4 24
Medium
25 $328,302 2
Out-of-
Network
HEART FAILURE & SHOCK W MCC
291 4.8 5.8 19
Medium
25 $234,101 3
Out-of-
Network
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE W MCC
190 6.1 4.8 15 Low 19 $188,029 4
Out-of-
Network
PSYCHOSES
885 7.3 7.9 11 Low 14 $85,527 5
34
Network Utilization Part B
Professional Details-2017
Specialty
In-Network
Professional Paid
Out-of-Network
Professional Paid
Patient
Count
Ophthalmology
$0 $754,698 1,166
Ambulance service (private)
$0 $713,082 602
Orthopedic surgery
$0 $395,781 835
Ambulatory surgical center
$0 $376,150 231
Diagnostic radiology
$0 $347,517 2,656
Cardiology
$0 $259,223 1,231
Internal medicine
$251,320 $253,643 1,295
Dermatology
$0 $251,841 845
Nurse practitioner
$98,094 $162,991 1,529
Anesthesiology
$0 $141,175 574
Clinical laboratory (billing independently)
$0 $135,609 644
General surgery
$98,652 $122,631 792
Nephrology
$0 $122,024 151
Physician assistant
$51 $120,277 693
Neurology
$0 $110,990 401
Chiropractic
$0 $107,107 387
Physical medicine and rehabilitation
$0 $100,910 381
Emergency medicine
$35,077 $77,842 537
35
Additional Opportunities
36
Steps to Take Now for ACO
Participation and Accessing
Medicare Claims Data
37
Consider Agreement Cycles
37
Track 1
o2018 was the last application
cycle for new Track 1 ACOs
•May continue out their term
through performance year 2020
•Will be allowed to apply for
Basic option but must begin at
Level B
BASIC Option
•Interim cycle for Basic option
begins July 1, 2019
•Regular cycle to begin January
1, 2020 and annually thereafter
•Interim six month “year” does
not require Level advancement
•Allows up to three and a half
years of upside-only risk for
new low revenue ACOs
ENHANCED Option (ongoing)
Same timeline as BASIC
No time limit for participation
Required start point for high-
revenue ACOs experienced
with risk
38
Consider Your ACO Options & MIPS
Participants joining the Basic option on July 1, 2019 will be
considered MIPS APMs for the 2019 performance year
Quality, 50%
Improvement
Activities, 20%
Promoting
Interoperability,
30%
• Scored from APM
quality measure set (no
additional submission
requirement)
• Measurement period
will be 2019 calendar
year (including July 1
starts)
• Same rules as standard
MIPS participation for data
submission (minimum 90-
day period)
• TINs weighted to yield a
single ACO score
• Automatic credit for ACO
activities. Historically
100%
As of 1/10/2019 pending
release of CMS guidance
documents
39
Consider MIPS-APM Participation
Also Simplifies MIPS Reporting
39
MIPS
• All eligible providers report all
categories except Promoting
Interoperability (which exempts
hospital-based physicians)
• Cost is claims-based and does
not require reporting
MIPS-APM
• All TINs report Promoting
Interoperability except
TINs that only include
hospital-based physicians
• Only PCPs (and specialists that
act like PCPs) report quality on a
subset of patients attributed to ACO
for primary care
Improvement
Activities
• PCPs
• Specialists
• Hospital-Based
• EPs
Promoting
Interoperability
• PCPs
• Specialists
Quality
• PCPs
• Specialists
• Hospital-Based
EPs
Cost
(Claims only)
• PCPs
• Specialists
• Hospital-Based
• EPs
Promoting
Interoperability
• PCPs
• Specialists
Quality
• PCPs
Qualified Advanced APMs Report Nothing!
